 The next item of business is a debate on motion number 2232 in the name of Donald Cameron on the NHS in Scotland. Can I invite members who wish to speak in the debate to press the request to speak buttons now? I call on Donald Cameron to speak to and move the motion. Mr Cameron, eight minutes please. The subject of the debate is, of course, the report of audit Scotland on the NHS in Scotland 2016. The report is now a week old. The picture it paints of the NHS in Scotland is, however, much older. That is the true tragedy here. As I will come on to later, the problems described are the same problems that Audit Scotland described ten years ago. That's ten lost years. Ten years of inaction, ten years of delay. Let me remind the chamber of some of the key points. Only one out of eight key performance targets met. The number of outpatients waiting for an appointment up by over 20,000 in a year. A recruitment crisis with skills gaps across the NHS. Those are just some of the damning statements in the report. I have always said that we would welcome successes when they arise. There are indeed small glimmers of light within this report, and it would be childish not to acknowledge them. Audit Scotland state that NHS Scotland met its drug and alcohol treatment standard, which we welcome. The answer target of 31 days between a decision to treat to first treatment, missed by a very marginal 0.1 per cent, and recognition that there has been a reduction in bed days from delayed discharge. However, whilst there are morsels of good news on any balanced view, this report remains a stark indictment of the SNP's handling of the NHS. Why do we keep hearing this? This SNP Government refused to acknowledge that, after nearly 10 years in their hands, the NHS in Scotland is in a critical condition, and the longer they bury their heads in the sand, blame other people and talk about a good record, the worse this will get. Unlike this Government, we want to analyse the problems facing our NHS, and more importantly, we want to talk about the solutions to make the NHS work not only for patients but also for the front-line staff who care for them. Such staff being one of the many reasons, people have such huge goodwill for the moment towards the NHS. However, that affection for the NHS does not mean that there are not fundamental problems with the way that it is being run here in Scotland. In this report, charge after charge is levelled and charge after charge is proved. It is a forensic critique of a public service on its knees, and it would be incredulous if the Scottish Government and the Cabinet Secretary to ffendr this report is anything other than deeply, deeply alarming. Any politician uses rhetoric at their own risk because its currency is devalued by overuse, but the position that we are in is more than challenging, it is more than difficult, it is truly a crisis. Take one aspect, the targets. As I have said, all but one missed, and some targets have not only been missed, they are going backwards. The 18 weeks referral to treatment time is down 1 per cent from last year. The 12-week treatment time is down 2 per cent from last year. The referral to outpatient appointments is down 3.4 per cent from last year. Those are not just mere numbers, they represent real people across Scotland relying on our NHS but being let down. Each missed percentage point is a person, each fraction is a family. As I said earlier, and as Ruth Davidson pointed out last week, Audit Scotland reports for the last 10 years have been warning the Scottish Government about a lack of a clear plan to deliver a better NHS and, crucially, have been warning about the failure to shift the balance of care. When the SNP took office in 2007, Audit Scotland and I have the report said that there was no evidence that resources are shifting from traditional means of delivering services to community-based services. John Mason. A member for Giving Way would you accept that if you shift services out of the acute hospitals into the community, that in the short term at least might even make the targets harder to reach. Mr Cameron. I thank you. I thank you so much. As I was saying, in 2008 Audit Scotland said that despite the Government's policy of shifting the balance of care close to home, there was no evidence available to show changes in the balance of expenditure. In 2009, I have the report, it said the same Maelchwyr fawr ar gyferio unigol, cymorth cerddur â'r brwyll Cymru, wrth gwrs, i gyrdd geitwyr. 2014-25, wrth gwrs, yn cael ei ddechrau, yn cael eu bod gan yn dweud. Diolch i fod yn cymorth cerddur â'r berthynas ar ginger, yn cael ei ddechrau i Gwynedd ysgoledig a'r ddechrau, ddweud o bod yn cael y gwirionedd yn cael ei ddechrau i graf o ddweud o'r nu ar g疫 Walkieannol. Diolch i fod yn cael eu hawdd i'r pryd g ôl i gyrddur community-based settings, and we know what this 2016 report says exactly the same thing. No progress, no shift in the balance of healthcare, and much more action required. Year after year, these warnings have been ignored, and we are now at breaking point. Despite this long wait, as I said earlier, I welcome some of the points made in the Cabinet Secretary's statement earlier this afternoon. I welcome that this Government intends to accelerate the shift from acute to primary community and social care. I welcome that this Government is committing to shift 50 per cent of front-line NHS funding outwith the acute hospital sector. However, the fact remains that this should have happened years ago when Audit Scotland first raised this issue. That said, as I read her amendment today, I was encouraged and I thought at last a genuine attempt to set out a list of actions, some of which we could support, but I should have known better. The final line refers to UK Government welfare policy. How depressing that, at the last, the Cabinet Secretary has chosen in her amendment to include a partisan red herring to try and shift the blame on to someone else. As far as I have been able to see, the Audit Scotland report makes no mention whatsoever of the effects of welfare policy, reverting to type, Presiding Officer, a typical attribute of this Government. Let's rise above it. It is clear that a fundamental change in direction is required. Carping from the sidelines is futile, and as a strong opposition, we do not intend to do that. I have said it before and I say it again. Blanket opposition to any change in the NHS is irresponsible. The NHS can never be static and we accept that tough decisions have to be taken. However, the current political debate is failing the NHS, because saving the health service now and for the future is more important than the politics of anyone here, and we want to contribute positively to that endeavour. That is why today the Scottish Conservatives are setting out 15 things that we say can be done both now and over the next few years to take our NHS through this difficult period, showing that there is a middle course between underaction and over-emotion. We are setting out several proposals that we feel can help our NHS grow, meet the challenges ahead and crucially ensure that many of the recommendations that have been routinely made by Audit Scotland can be met. For example, we are calling on the Government to consider the following, to consider giving immediate clarity over which services will change and which will not, in the next six months to evaluate the impact of splitting elective and acute care, to expand mental health services into primary emergency and community settings, to publish a national workforce plan and commit to six-monthly updates to this Parliament. These are just a few examples—just sensible, straightforward and pragmatic points that should be being done but are not. In order to solve the problems that exist, new ideas are required. To sum up, if the SNP truly cares about the future of our health service and wants to provide better government for Scotland instead of endless constitutional naval gazing, it must deliver an NHS fit for not just the next five years but the next 25 years and beyond. I hope that this Audit Scotland report goes down in Scottish political history as a seminal moment in the story of our health service. I hope that this report really does mark a turning point, because we are truly at the stage of make or break. Audit Scotland has provided a balanced overview of the NHS and makes several recommendations that we accept in full. As we consider the report, we have to recognise the challenges in our health services, but we also recognise the many achievements. First and foremost, with patient satisfaction levels up to 90 per cent, I will begin the statement by highly commending the commitment of all our staff across the NHS in Scotland. It is our staff, our nurses, midwives, doctors and paramedics, whose dedication allows us to meet the challenges that we face and implement new initiatives to ensure that we continue to deliver a health service that we can rightly be proud of. I am proud of the national health service and I am proud of the record level of investment of close to £13 billion committed by this Government. I am proud of the highest ever levels of staffing and I am proud of our improvements in health, patient safety and survival rates. All of those investments were recognised in the Audit Scotland report, and this Government wants to go further to ensure that the NHS receives the resources that it needs to be equipped for the future. For example, having increased front-line health spending by 8.2 per cent since 2010-11, we will go on to increase the NHS revenue budget by almost £2 billion by the end of this Parliament, the highest commitment of any party in this chamber. However, we need to do more than just give the NHS extra money. As I said earlier this afternoon, the NHS cannot stand still. We need to reform. We all recognise the nature and scale of the challenges that are facing our whole system of health and social care, and that is why we will continue to drive forward our significant programme of transformational change. It is a strategy that is founded in our twin approaches of investment and driving reform. It underpins our 2020 vision and will be delivered through the key programmes of work. We will continue to deliver integration of health and social care. We will implement our national clinical strategy with its recognition of the need for new investment, new ways of delivering medical services more effectively to communities and new approaches to practice. We will accelerate reform of primary care and our comprehensive approach to public health improvement. To support those programmes, we will develop a national workforce plan. John Scott, on transformational reform, are you aware that at air hospital between April and September this year, there were a total of 7,594 missed appointments, representing 9 per cent of appointments? That figure is presumably replicated elsewhere in Scotland. Do you agree that, if that problem could be addressed, it would go a long way to reducing pressures on our overburden NHS? I agree with John Scott that missed appointments are a challenge that we need to address. Of course, boards are looking at ways of addressing that through text messages, follow-up and reminders. I do not think that the answer is what the Tories are proposing, and that is charging people for missed appointments. That compounds health inequalities in our society. I hope that I have managed to lay out an intense level of activity that we are undertaking to meet our aspirations on the 2020 vision, and we have to move at pace. For that reason, by the end of this year, as recommended by Audit Scotland, I will present a transformational change delivery plan that will bring all those different elements together to deliver that vision together in a single framework. The Audit Scotland report confirms our strategy is the right one, and we need to work together across this Parliament and with our colleagues in health boards, local government and in the workforce to progress it, to ensure public confidence in it and to make it happen at pace on the ground. It is the right plan, and given no one and no party in this chamber has come forward with a different plan, and I have looked at the Tories' plan, and it is mainly ours with a few small additions. I suppose that imitation is the best form of flattery, but I hope that we will get the backing of this Parliament in its implementation. We know that simply doing more of the same things faster will not deliver the standards of care to which people in Scotland should have access. We also need to make sure that the mechanisms that we use to measure performance keep pace with our wider reforms and commitment to improvement. To do that, we have put in place a review of targets and indicators for health and social care. That review will ensure that targets and indicators lead to the best outcomes for people being cared for, whether in hospital, primary care, community care or social care services. I am delighted that Harry Burns has agreed to bring his expertise to the role of independent chair of the review, and I am sure that the chamber will support Harry in the review, along with support from across the different sectors and professional bodies that provide care. The Government is serious about ensuring that people are supported to maintain their independence for as long as possible in their homes and communities, and that fewer people need to go to hospital to receive care. Where hospital care is necessary and appropriate, people should spend less time there and return home more quickly. I am pleased that delayed discharge has reduced under this Government, and I remain committed to eradicating it by continuing to invest in preventative rehabilitation services. We know what works. If all partnerships were delivering the reductions in delay achieved by the top 25 per cent, we would immediately halve all delays, so we will work with partnerships to help them to deliver change to reduce delays. In our manifesto, the First Minister outlined SNP's continued commitment to the six essential actions for A and E, which was launched a year and a half ago, and that has led to significant improvement in unscheduled care. It is a home-grown programme to improve whole-system emergency care based on clinical feedback and produced jointly with the Academy of Royal Colleges and the RCEM. There is no coincidence that Scotland's core A and E departments have been the best performing in the UK for the last 18 months, and that is a credit to all those involved. Despite those improvements, we absolutely recognise the challenges that are facing up to those. We recognise that, while we have a huge amount of work still to do, there is a general consensus and enthusiasm nationally, locally and with representative bodies to enhance patient experience and ensure optimal care. Audit Scotland recognises the need to make a real shift from relying on treating people in hospital to providing care in the community and primary settings, as well as in the home. We agree, and that is why we are increasing the share of the NHS budget dedicated to mental health and to primary community and social care. The First Minister announced an additional £500 million to be invested in primary care, helping to shift the balance of care. I am sorry Cabinet Secretary, can I ask you to wind up? Time ever, at least half of front-line spend being outwith acute hospitals. Presiding Officer, as I bring my remarks to close— No, you have to stop. I am sorry. We are very tight for time. Thank you very much. I now call Anna Sarwar, please, to speak to a move amendment 2232.1. Mr Sarwar, please, you have five minutes. Thank you, Deputy Presiding Officer. I would like to again welcome the cabinet secretary to the chamber. It is nice to see her twice in one day and no one to hide behind it. Last week Audit Scotland published its annual state of the NHS report. It was the worst report on the NHS since devolution, a damning indictment on 10 years of SNP mismanagement of our NHS, and it lays bare the failings of the cabinet secretary and the failings of her Government. No amount of Government spin or warm words from the cabinet secretary can hide the fact that Audit Scotland—an authoritative, expert and crucially independent body—has painted a picture of an NHS in crisis. Only one out of eight patient standards met. Not just a statistic, but behind it thousands of patients and families who have been let down. But this is not just one bad report. It identifies a trend under this Government and this Cabinet Secretary. In 2013, only four out of eight standards were met. In 2014, only three out of eight standards were met. In 2015, only two out of eight standards were met. Now, in 2016, only one out of eight standards met. What does it have to take before the cabinet secretary recognises that the NHS is in crisis? Do we have to hit zero before any admission of the failures of this Government? At its heart, the report reveals one key failing, and that is in workforce planning. It reveals a Government letting down our hard-working and dedicated staff, doctors, nurses, midwives, healthcare assistants, porters, physiotherapists, radiographers and so many more. Too few staff working too many hours dealing with too many patients but without the support or resources that they need to do the job properly. I have heard people on the Government benches say that exposing the failures of the Government on the NHS somehow lets down our hard-working staff, but be in no doubt that the betrayal of our staff comes not from those exposing this Government's failures but from those who willfully under resource, under value and overwork them. I want to use this moment to thank all our staff who have dedicated their lives to caring for others. It is you and your patients that we are fighting for today. We have heard from nursing leaders themselves that their workforce is reporting an inability to cope with a workload and it is only getting worse. It is simply unacceptable that we now have more than two and a half thousand nursing and midwifery vacancies. As a direct consequence of that, we have seen spending on private nursing agencies skyrocket. The Audit Scotland report found that the cost of the NHS of a whole-time equivalent private nurse to an excess of £80,000 a year, but an NHS nurse only costing £32,000 and local consultants earning as much as £400,000 per annum enough to pay for four NHS consultants. £173 million spent on private agencies at the same time as this Government is cutting budgets. On budgets, the independent Auditor General confirms what Labour has been saying for months. This year, there will be almost £500 million of cuts. On top of the £300 million last year, those cuts are having a direct impact on staff, on patients and on services. Deliberate, conscious, calculated decisions to force cuts on health board after health board and those decisions have consequences. The health secretary let the cat out of the bag when she said on GMS on the morning of the publication of the report that Labour should stop, and I quote, putting blocks in the way to any changes to services in Parliament. I am closing, Deputy Presiding Officer. The services that we are trying to stop, the closure of at the Vale of Leven, the REH, Inverclyde and Lightburn, were all that were promised as being safe by this cabinet secretary. However, there is an alternative. We could use the powers of the Parliament to invest in social care and invest in front-line services. As the Royal College of Nursing said, how many more reports will be published by Audit Scotland before action is taken? Patients, staff and families deserve a decisive response from this cabinet secretary. Well, cabinet secretary, what should it be? I formally move the amendment in my name. Now we want the open debate. It is a tight four minutes for speakers. I will try to give time for interventions, but please make them short. I call Miles Briggs. We are followed by Ash Denham. Mr Briggs, please. Our NHS workforce is doing an amazing job. What is clear is that none of the criticism regarding the performance of NHS Scotland is aimed at the work that it does to deliver health services to communities across our country. The Audit Scotland report has set out clearly the major key challenges facing the health service in Scotland, perhaps as Anna Sauer suggested, specifically around recruitment and retention of staff within the service. It is increasingly clear that this Government has failed to deliver a sustainable workforce in Scotland. The impact of that is affecting the delivery of key services and the meeting of the Government's own health targets. How have we reached that position? It is worth reflecting that the student nurse numbers were cut by this Government by around a quarter between 2007 and 2013, particularly between 2011 and 2013 by the current First Minister while she was health secretary. That is clearly impacted on our health services, and as the Royal College of Nursing briefing ahead of today's debate states, our health service is now reaping the consequences of decisions taken by Government at this time. The financial position of our health service is also of great concern, as outlined in the Audit Scotland report. As a Lothian MSP, I am acutely aware of the financial challenges facing my own local health board here and how that is impacting on the delivery of health services to the people whom I represent in this Parliament. However, behind those statistics, as Donald Cameron has mentioned, let's not forget that we are talking about people, our family, friends and neighbours. As has already been mentioned in the debate, health boards have failed to meet seven out of eight key national targets, reporting lengthy waits for emergency treatment, inpatient appointments, cancer treatment and mental healthcare for children. Given the concerns being expressed by alcohol and drug partnerships across the country surrounding their funding arrangements, I would question whether, too, we will be able to see them maintain the service that they provide and meet the treatment targets that they have set in the future. The Scottish Government has a waiting target for orthopedic appointments of 12 weeks from the date of receiving a GP referral. However, NHS Lothian admitted to me in a letter only last week that such is the increasing number of patients referred to orthopedics in the Lothian region, that they are finding this impossible to actually meet the target. I have a number of elderly constituents in desperate need of hip replacements and in severe pain every day, facing waits that they have been told could be up to seven months, just for an initial consultation with an orthopedic consultant. This is clearly unacceptable and is happening on this Government's watch. In fact, the Audit Scotland report outlines that this number is increasing with over 2,750,000 out-patients waiting just for an appointment. All organisations and political parties agree that we need to see a shift and a shift in the balance of how care is provided and delivered away from an acute setting. We agree, but the question that is being asked again and again is whether the Government is providing the leadership that is needed to achieve that. Sometimes in politics— Members in his last minute, I am afraid, are very short. Do you recognise the 200 million investment in the elective centres, which is absolutely to address the hips and knees and eyes of the future that his constituents are requiring? I do, but it is how this is impacting on healthcare here in Lothian. As I have said in my speech, I have constituents coming to see me who are being told that they have got seven months before they can have this treatment, but are told that they have got 12 weeks to wait. Sometimes in politics, reports are published that should act as a wake-up call for Governments of the day. I have no doubt that last week's publication of Audit Scotland's report is just one of those. I started my speech by paying tribute to those who work in our health service. Increasingly, I am sorry to say that it seems that they are lions led by SNP Donkeys. There are significant challenges facing our beloved NHS. Some of those challenges are very serious and will require new ways of working. Some will require creativity and all will need serious levels of funding in order to solve them, but they are, however, in no way unique to Scotland. We are facing budget challenges, we are facing ageing population challenges and we are facing huge price hikes for essential life-extending medicines. Again, those same challenges face many countries like us right now. Indeed, those same challenges currently face the rest of the UK. That has led the Auditor General for Scotland, Caroline Gardner, to comment that we know many of the pressures that we are seeing in Scotland apply across the UK and elsewhere. Scotland's performance stands up well against that and against that of the rest of the UK. This year, the NHS budget is £12.2 billion, which amounts to 40 per cent of the Scottish Government's budget. That is a serious commitment by this Government to the NHS. By the end of this Parliament, health funding will be at least £500 million more than inflation only increases, and that was a manifesto commitment that only the SNP had. This level of financial commitment has allowed overall staff levels to be at their highest ever level, with over 138,400 whole-time equivalent staff as of March this year, and that is an increase of 11,000 staff since the SNP came to power. That is more staff across the board from nurses and midwives to GPs, paramedics and oncologists. That level of financial commitment is made all the more remarkable when it is set against the fact that the money available to the Scottish Government has been rapidly dwindling. Of course. Mr Briggs, briefly. G would you like to acknowledge to Parliament that, since 2010, the UK Conservative Government has provided £1.46 billion in Barnett consequential funding for our health service in Scotland? The money that has been passed on, but I wonder whether the member wants the Scottish Government to follow the Conservative Government's example, which in England has led to striking doctors, low morale, an A&E crisis and chronic levels of underfunding. No, thank you. The UK Government has reduced Scotland's fiscal del budget by 10.6 per cent in real terms between 2011 and leading up to 2019-20. The rising costs of drugs is another major pressure. The NHS spent £150 million more on drugs in 2014-15 than the year before, and that is even adjusting for inflation. An increase of over 10 per cent in one year. NHS boards in Scotland have been successful in increasing the prescribing of unbranded medicines, rather than branded, to generate efficiencies, and Scotland has one of the highest generic prescribing rates in the world. However, there is even a trend for unbranded drugs to be subject to massive price hikes. In one example, prescriptions of a drug for IBS fell by a third, but the overall cost to the NHS rose by 300 per cent because of an increase in price. By 500 per cent, Westminster is taking action on this and a bill limiting unbranded drug price rises is expected to be enacted next year, and that is a welcome development in this area. No one wants their loved ones to miss out on new or potentially life-saving drugs, so the Scottish Government has provided more money through the new medicines fund, which has gone up from £21 million in 2015 to £85 million in 2016. We are in a position where we must do more with less, while still striving hard to provide high levels of service to patients. The Scottish Government places a high priority on resourcing the NHS, but also in developing it to meet the issues that we are facing as a society head on. Thank you very much. Thanks, Presiding Officer. I declare an interest in both my wife and daughter's work with the NHS. Let no one in this place be under any illusions that the publication of the audit Scotland report last week was, I believe, a watershed for the NHS in Scotland. For years, patient staff, families, elected representatives and trade unions have known about the mounting pressure that is facing the NHS. Every one of us in this room has been lobbied by people raising their personal concerns. Many of those concerns have been dismissed by ministers who respond with robotic statements railing off numbers and percentages from their ministerial briefing folder. All of that is unrecognisable to the patients, staff and dogs in the street who all know full well the impact of the pressures on their loved ones. Audit Scotland has surely confirmed once and for all that none of those concerns are scaremongering. None of them are talking down staff nor undermining our greatest public service. It is simply a reflection of the material reality being expressed, but it is being experienced every day by NHS patients and staff. I hope that the Government starts to listen and take responsibility. No more diversionary tactics, no blaming someone else, no wishing away the array of problems that the report exposes. Early on, the report gets to the very heart of the issue. It says that NHS funding is not keeping pace with increasing demand and the needs of an ageing population. The First Minister and the Cabinet Secretary will claim that record funding is going into the NHS. If record funding is going into the NHS, isn't the Audit Scotland report a damning indictment of the mismanagement and effectiveness of that record funding? Football club owner or manager can put record funding into a team, but if the results continue to be poor, those painter wages rightly call for their head. The truth is, health inflation is at 6 per cent, and demand is rising, yet boards have received just over 1 per cent. Only one standard met from eight, agency spend up, vacancy rates soaring, a GP crisis, social care on the brink. In the real world, that means that people like my constituent, James Nielson, mentioned at First Minister's questions last week, unable to walk because of a block artery waiting toll to wait over 30 weeks just to be assessed. People stuck in hospital when they could be at home, mental health patients going through a crisis with no support and more and more people unable to get a GP appointment. The tragedy is that there are thousands more James Nielson's out there. NHS Lothian has already warned us that they will fail most of their treatment time guarantees as a result of the so-called efficiencies that they have to make. When will we stop hearing ministers and civil servants misleading the public? If you can't meet legally binding treatment time guarantees, then for heaven's sake stop taking the people for fools by calling these cuts efficiencies. It's people who suffer when targets are not met. It's people who suffer when the workforce is under pressure and it's people who suffer when they can't get an appointment with their GP. Finally, I must direct this across the chamber to the Tory party. The irony of them coming to this chamber lecturing anyone about the national health service, the greatest piece of social legislation ever introduced, is beyond satire. They would privatise it, outsource it, sell it off and break it up in a heartbeat. We must invest in our public services. We have to use our resources effectively. The Audit Scotland report suggests that the Government is failing miserably on both counts. Thank you very much, Mr Findlay. Alison Johnstone, do you want to talk about Alec Cole-Hamilton? I would like to begin by thanking Audit Scotland for its far-reaching detailed report and the crucial recommendations that it makes. The report rightly criticises the Government for the lack of detail that it has offered on major service reforms. David Hogg, a GP based on Arran, told the Health and Sport Committee yesterday that we cannot talk about realistic medicine without presenting realistic plans for service delivery. I am glad to see that the Government's amendment establishes a timeframe for delivering the cohesive framework that Audit Scotland has asked for, and I want to see it delivered by the end of the year, as promised. Audit Scotland's call for three-year financial frameworks for health boards is a sensible move forward, and I hope to see it included in the Government's plans. At this point, it is also worth asking what recommendations Audit Scotland would have made to this Parliament. I do not think that it advised us to keep retreading the same debate that we seem to consistently be having. The report makes it perfectly clear that, even with real-terms increases to the overall health budget, spending is not matching increased public demand. Shortcomings in funding and service delivery are not acceptable, but we need to pair criticism with proposals for action. Once again, a wholly critical motion has been presented by a party that consistently resists any moves towards more progressive taxation and refused to take a realistic approach to funding high-quality public services. I do not know how the Conservative Party thinks that we are going to develop more sustainable health services without fairer public spending and taxation. I do not accept the charge that we have not produced any proposals. We produced a 15-point plan with the number of ideas in it and are trying to create a positive prospect for the NHS. Will the Green Party echo that? It is fair to say that the NHS is having to deal with the impact that Tory austerity has had on many of our most vulnerable citizens and that this Parliament has had to spend money mitigating many of those damaging cuts. It would have been nice to see some of those constructive proposals in Donald Cameron's motion today, but it is absolutely right to criticise the Government for doing too little to shift the balance of care. The Royal College of Nursing calls the pace of change painfully slow. However, although it does not feel comfortable for any of us to say this, we need to think carefully about our approach to service redesign. Audit Scotland states that NHS boards face significant political resistance when they propose change to services. I agree that there have been real issues with public consultations on some of the service changes that health boards have proposed. Part of the problem, as Audit Scotland points out, is that neither the Government nor individual health boards have done enough to open up meaningful public conversations about the long-term direction of service delivery. Parliament has an incredibly important role to play here, too, to debate those issues broadly and openly and collaboratively wherever possible. The BMA puts a very blunt statement to us. It says that there needs to be a significant increase in the investment to close the funding gap. If there cannot be a commitment to more resources, then a range of realistic future health service models using current planned resources must be set out. The truth, I think, is that we need to do both. We need sustainable investment in our health services and we need to think about future health service models that meet the complex needs of all. Audit Scotland has asked the Government to model the cost of implementing the national clinical strategy. I want that model to consider the contribution that health services make to local communities and local economies, because I think that that has been really lacking so far. We cannot have a fully informed debate about the impact of service changes without understanding the economic and social role that health services play in different parts of Scotland. We need to ensure, too, that equitable access to primary healthcare is available. I would like to point out that yesterday— No, you cannot. I am afraid that you cannot point out anything further. You must conclude. Sorry. Thank you. I call Alex Cole-Hamilton. We are followed by Ross Thompson. Mr Hamilton, please. Thank you, Deputy Presiding Officer. The SNP is able to win elections, but seemingly unsure what to do thereafter. The danger is that Nicolaus Government end up simply managing, not leading. I ask the member to use full names in the chamber. I am actually quoting somebody here. I will come to that, but Nicolaus Service Government end up simply managing— Well, you did not say I quote. Slow down. Slow down. Can I have the time back? Let's make it clear you are quoting or I will misunderstand you. Right. And heaven for a friend, I do not want to do that, Mr Cole-Hamilton. I have some time added on at the end. For Hamilton, I will decide where the time back and the answer is yes. Thank you. In the sage words of your friend and mine, Kenny MacAskill, the SNP is able to win elections, but seemingly unsure what to do thereafter. The danger is that her, Nicolaus Sturgeon's Government, end up simply managing, not leading the political agenda, much indeed as Labour did in the years before devolution, mitigating austerity, but managing decline words that are now being stenciled to lunchboxes across the unionist movement. If the measure of a civilised society is how we care for our sick and infirm, then by any stretch of the imagination, the SNP Government are failing on many of those tests. In any other profession, the senior management team of an organisation that had 10 years to fix the problems and meet the cave performance indicators before it had spent so much money into doing, they would be on their final warning. And as report cards go, that published by Audit Scotland was excoriating. It reads like a horror show. By any stretch of target, it is a target-rich environment for Opposition spokespeople. However, in the ministerial statement that we had this afternoon, well padded out with sycophantic questions from Government benches, we heard what not one admission of failure. The first step to fixing a problem is admitting that you have it in the first place. Nearly two years ago, the cabinet secretary said, I want over the course of this year to eradicate delayed discharge out of the system. I am absolutely determined to do this. However, Audit Scotland, in its report, cited glacial progress in this area at best. This is the question that I would have asked in the statement. On Monday, a family came to my surgery for siblings, whose 83-year-old father, a resident in Cresdorffan, by the name of George Ballantyne. George had a fall in March and was taken to Liberton hospital after treatment and a mild infection. He was declared fit to go home in June. Following extensive renovations and adaptions to his house, he was told on three separate occasions to prepare to go home the next day. Yet, this evening, he will spend his 150th night in Liberton hospital since he was told that he was fit to go home. Given that she comprehensively failed to address delayed discharge in her statement earlier, will the cabinet secretary or her ministers now explain to Mr Ballantyne in her summation why he is still in hospital tonight? The fact is, Presiding Officer, that integration of health and social care, which promised so much, has been underfunded and has not been properly orchestrated, and it is failing patients across this country. Right across Audit Scotland reports, we see failures. However, Donald Cameron is right to point out successes. I do accept that meeting the target on three-week treatment waiting time for drug and alcohol is well met, and it is to be supported. However, what the Scottish Government does with one hand is to take away with the other, because you can bet your bottom dollar that a 22 per cent cut to alcohol and drug partnerships in our communities will see that progress eradicated. Put simply, as I said yesterday, in Edinburgh alone that equates to 1.3 million year-on-year service cuts, that is a fire sale, and it is going to fail—it is a cost that is going to be measured out in human lives. On this most solemn, most important duty, the SNP has been found wanting. When they ask those opposition benches what would you have done differently, they are often offered alternatives, yet they ram fingers in their ears and bury heads in their sand. I'll conclude with this. The eyes of the nation are on this Government to discharge its duties in this area. Who can blame them if they now wish to turn away in disgust? Thank you very much, Mr Cole-Hamilton. Paul Ross-Thompson will be followed by Claire Hawke. Thank you, Deputy Presiding Officer. Anyone watching this debate at home will no doubt feel a sense of deja vu, as this Parliament discusses another Audis Scotland report, which again highlights serious strain in our NHS on services, staff and on patient care. Just last week, the First Minister played to our nationalist-backed benches who were no doubt impressed by her warm words on the state of our NHS. However, the public are less than impressed, and I can assure the First Minister that residents that I represent in the north-east of Scotland are less than impressed at the latest Audit Scotland report, highlighting still the unresolved challenges of a severe skill shortage and the struggles that we face recruiting and retaining medical staff. In 2015-16, the staff turnover in NHS Grampun was 8.9 per cent, considerably higher than the national average of 6.4 per cent. Figures from June showed that emergency medicine consultancy had a vacancy rate of 26.3 per cent in NHS Grampun compared to that of 9.7 per cent for Scotland as a whole, almost three times that level. Further, the most recent primary care workforce survey showed that in NHS Grampun, over two thirds of shifts were unfilled 48 hours before workdays, weekends and public holidays. In the midst of this recruitment crisis, the Scottish Government continues to impose caps on the number of domiciled Scottish students who attend our universities, and in particular towards those who wish to study the very subjects that could help to resolve the catastrophe. When the residents that I represent are experiencing a decline in the quality of service, when they tell me that NHS Grampun is reaching breaking point, it simply beggars belief that our universities are forced to turn away talented Scots due to bad Government policy. I have only got four minutes, minister. The current capping policy is simply making the situation worse. Just over 1,030 Scottish domiciled students applied for medicine courses starting in 2017, and an 11 per cent drop over the last five years. The situation is so poor that the leadership of NHS Grampun have expressed deep concern. Speaking in evidence to the health and sport committee only last month, Gerry Lawry, the deputy director of workforce, said that she was extremely disappointed by the dramatic fall in the number of local trainee doctors. She said, and I quote, When I started my career in the NHS, 95 per cent of the junior doctors were trained locally. Twenty years down the line, I'm lucky if that's 50 per cent, and I'm disappointed Aberdeen University has been reducing numbers because we're struggling to recruit, not just in primary care, but other areas too. In response to such a damning criticism, the health secretary denied that there was any crisis in GP recruitment. Clearly, the trappings of high office are preventing ministers from seeing what's happening on the ground, or perhaps they're just blatantly denying their existence because it's more convenient. Audit Scotland reported on NHS Grampun's financial settlement, and there in black and white you can see that the region is 1.4 per cent below their NRAC allocation. Six years after the funding allocation formula for health boards was introduced, that is an astonishing £12.2 million. That is £12.2 million that NHS Grampun should get, but don't get. Despite all of this, NHS Grampun is still being asked to make efficiency savings of 3 per cent this year. This is more evidence that, as with all other public services, the SNP is short-changing the north-east of Scotland. Deputy Presiding Officer, in our Parliament, we have the full power to deliver an NHS fit for the future. However, since May, the priority of this Government has been to posture on Brexit and consult on another divisive and destructive referendum. The SNP has given up on governing for Scotland, and it is clear that its obsession of separation transcends the quality of patient care. Audit Scotland reports that there is still work to be done. However, as my colleague Ash Denham said, there is nothing unique about the challenges that are faced by the health service in Scotland. Those are challenges facing the Administrations throughout the UK and many other countries worldwide. The Scottish Government is focused on meeting those challenges. However, unlike the crafters of this motion, Audit Scotland also acknowledges some that has been achieved by the Scottish Government. For instance, and I quote from their document, over the last decade, there has been improvements in the way health services are delivered and reductions in the time that patients need to wake for hospital in-patient treatment. There have also been improvements in overall health, in life expectancy, patient safety and survival rates for a number of conditions such as heart disease. Audit Scotland acknowledges that the demands on health and social care services have been increasing because of demographic changes. People are living longer with multiple long-term health conditions and increasingly complex needs. As a nurse and a trade union official in the NHS, I knew only too well the challenges that were faced by staff and management over the years that I was employed in the service. I also have first-hand experience of the hard work, the diligence and compassion of nurses and midwives, medics and EHPs throughout the NHS, supported by lab staff, admin and facility staff. Those are the qualities that they bring to their workplace every single day, as they seek to help and care for their patients. This dedication and hard work is acknowledged in the recently published High Patient Satisfaction Rates, with over 90 per cent saying that their overall care was good or excellent. However, I would not want the members on those seats to let an accurate health statistic get in the way of them scoring cheap political points and undermining the good work of their NHS staff. It is right to acknowledge the challenges that are facing the health service, and the SNP Government is doing that. It is not just acknowledging it but tackling the challenges. It is addressing those through reform in areas such as health and social care integration and moving the focus of care from hospital to community settings. NHS staff is at record levels and up more than 11,000 are under the Government. Looking forward, the service faces challenges in recruitment, and the Scottish Government has been working with partners to address those challenges. However, this task is not being made any easier by the recent actions of the UK Tory Government, particularly by following changes to UK immigration rules around post-study work visas and its dismissive attitude following the Brexit vote to the fate of thousands of EU nationals on whom the health service and social care providers rely. At yesterday's health and spoken committee, we heard of a stark example of how our rural health services rely on overseas borne staff. Of the 13 consultants employed in western Isles, only one is Scots borne. They have been actively recruiting to other vacancies in Spain, but uncertainty around the status of EU nationals post-Brexit may hamper their efforts. Given that this is a consequence of a situation wholly attributable to the UK Conservative Party, the irony of the Conservatives in this chamber crowing about the recruitment challenges faced by the Scottish NHS will not be lost on my constituents. As we watch with concern the mismanagement of the English health service under Tories and Westminster, including increasing privatisation and a record number of trusts in special measures, including another one yesterday, for either quality or financial reasons. I, for one, am thankful that we have in Scotland a devolved health and social care service and a Government with a strategy for ensuring that it evolves to meet the needs of our people. I am sorry to say to Mr Mason that your speech is now three minutes. We will try to make it up just another day. I might hold you to that. I will therefore not take any interventions during my speech. I would like to start off with some of the key messages and some of the wording that actually appears in the report. For example, under the summary, the key message starts off over the last decade. There have been improvements in the way that health services are delivered and reductions in the time that patients need to wait, etc. That is certainly a very positive start, despite what some in the Opposition have said. Then, under point 3, it says, however, boards are struggling to meet the majority of key national standards and the balance of care in terms of spending is still not changing. If I want to concentrate on one point this afternoon, it is this. Are we serious about community and preventative care? Or are we only serious about targets that are easy to measure? Are we willing to sacrifice some hospital targets in the short term in order to invest more in primary care and prevent hospitals being needed so much in the longer term? We move on to part 1, which deals with financial and service performance. Key message 3. NHS boards need to look at reorganising acute services to free up more resources for investing in community-based facilities. Why is that not happening? Will the report go on to explain? Alison Johnstone quoted that already. However, the health boards are often faced with considerable public and political resistance to propose changes to local services. That is a point that both the BMA and the RCN also make. The RCN says that health boards are caught in a crossfire of political and public opinion. The BMA says that politicians are quick to criticise plans' service changes. I think that we virtually all agree that we should emphasise the community, but it is just too easy for the opposition to say that it is all a crisis. Someone had to wait too long for a hospital appointment, someone else did not get the expensive drug that they wanted. Perhaps we as politicians all need to take more collective responsibility. The NHS can never provide all that people want, and we need to switch resources to the preventative and the primary side. The report actually says that we need to manage expectations. Do Opposition members agree with that part of the report? Will Opposition members help, commit to help, manage expectations? The key messages that we have in the heading, although health spending has increased and it is not keeping up with growing demand and the needs of an ageing population. The suggestion seems to be that demand and needs are the same thing, but surely they are not. I will not expand on that point, as I do not have time. We are all proud of our health service, we all want the best for our health service, but all of us need to be a bit more honest and a bit more realistic with the public. Thank you very much and thank you for taking just three minutes. I call on Colin Smyth, please, to wind up for Labour. Four minutes please, Mr Smyth. Thank you, Deputy Presiding Officer. For the record, can I declare an interest in relation to the debate? When I was elected in May, I was employed by Parkinson's UK, although that employment ceased in May. I am also a local councillor in Dumfries and Galloway. Today's debate has given members an opportunity to reflect on Audit Scotland's assessment of nearly 10 years of SNP control of our NHS. Had it not been for opposition time and opposition pressure, there would have been no debate, there would have been no last minute statement earlier today from the cabinet secretary. He can see why the SNP did not want to talk about this report. It is a damning verdict on nearly a decade of SNP mismanagement of an NHS in crisis. Seven out of eight key patient standards missed, unprecedented financial cuts facing health boards, a soaring drugs bill, a recruitment and retention crisis across nursing, GPs, consultants and social care. However, that crisis was entirely predicted. The Audit Scotland report is like Groundhog Day. We have been here before. Audit Scotland, the BMA, the RCN and others warned six years ago that this was going to happen and their warnings were ignored by the Government. Even today, the SNP amendment talks about the need for change, but then says that we will have to wait until the end of the year for a change plan. More dithering, more delay from the cabinet secretary. If only the SNP had been in power for the last 10 years, maybe we would have had a plan by now. As Auditor General says in the report, no one disputes the need for change, the need to shift the balance of care from hospitals to the community. Despite that being the Government's policy aim for a decade, they have very little to show for it. However, where the report really exposes how utterly divorced the Scottish Government's rhetoric is from reality is when it comes to funding the NHS and social care. Day after day, we are subjected to sycophantic press releases from the Government telling us that money is pouring into the NHS if only staff weren't so inefficient in how they used it. Yes, there are inefficiencies, spending £7.5 million more on agency nursing costs caused by an utter failure in workforce planning by the Government is certainly one of those inefficiencies. However, as the report says, the simple truth is that NHS funding is not keeping pace with increasing demand and the needs of an ageing population. The Government needs to start being honest with the public and admit that health boards do not just have to make efficiency savings, they are being forced to make cuts to services that they do not want to make and which have nothing to do with change just to balance the books. When will the Government start to accept that, for all its rhetoric about increased investment and moving the balance of care to the community, its nasty and vindictive attacks on local government budgets are having entirely the opposite effect? Does the Government seriously think that it can savage council budgets by 25 per cent and expect that not to impact on social care or the many initiatives from councils so crucial in supporting the health needs of our local communities? It is time that we had an open and frank discussion about what we want from health and social care and how we plan to pay for it. I agree entirely with Alison Johnstone that it is time to admit to the public that if we want to properly fund social care, face with the massive rising demand, that will mean using the tax powers of this Parliament and asking those with the broadest shoulders to pay a little more. However, that is not what the position is set out in the Scottish National Party's amendment. It is time that we had a coherent joined-up change programme that is built on genuine consensus with staff and the public, not the arrogance that we have from the Government as they pat staff and the public on the back, but dismissed their genuine concerns over service cuts with a dismissive, we know best attitude. It is time that the Scottish National Party and its Cabinet Secretary took responsibility for the failure that is set out in what is unquestionably the worst Audit Scotland report since devolution, a report that is published on this Government's watch. Thank you very much, Mr Smith. I call Shona Robison to wind up the Government, Cabinet Secretary, in a tight five minutes, please. The only point that I would make to Colin Smith is that this SNP Government stood on a platform at the last election with the biggest investment on the NHS of any of the other parties, and we were elected on that manifesto. Labour was roundly trounced and came third on their manifesto commitments. I think that the people have judged who they believe are the better stewardship of the NHS, and that is those benches, not the Labour benches, if I could very, very briefly. Ms Bailey. The promise is made in the election. You promised my community that services would be protected at the Vale of Leven hospital. I would like nothing better than for you to keep that promise. We have saved the Vale of Leven from the cuts that the Labour Government put in place to undermine that hospital. Our commitment to the vision for the Vale remains. As I set out in my statement, there is a process of consultation under way about any changes, and Jackie Baillie knows that fine and well. If I can move on to some of the comments, I will continue them in a minute. Donald Cameron talked about welcoming the commitments that were made in my statement, and I welcome that welcome. However, he then criticised us for mentioning the welfare changes of the UK Government in our amendment. I think that it is very remiss of the Tory benches not to understand the impact of welfare changes on health inequalities. If you do not think that welfare changes are having an impact on health inequalities and you are living on a different planet from the rest of us, of course they do. It is quite right and proper for those to be recognised in this debate this afternoon. Miles Briggs talked about the issues in NHS Lothian on orthopedic weights, and I absolutely understand that we are working with NHS Lothian to overcome those. I will have more to say on outpatient appointments and helping boards to tackle some of those outpatient weights soon. In intervention to Miles Briggs, I made the point that we have a plan for elective centres, two of which will be within the east coast, which will have a direct impact on some of those demands for hips, knees and eyes, not just now but into the future with the ageing population. Miles Briggs mentioned the funding of the UK Government. However, last week, the UK Parliament health committees very forensically dismantled the claims of the UK Government—about 10 billion funding claims—as incorrect and misleading. It does not do the Tory benches any good to start lodding what the UK Government claim that it is spending on health when the health select committee has only just this week driven a coach and horses through those claims. I think that you need to perhaps reflect on your own UK Government's performance around the financial support to the NHS. Ash Denham made some very important points. She reminded us of the Audit General's quote about Scotland's NHS performance, which stands up well against the performance of the rest of the UK. I am not claiming that we do not have challenges. I set out in my statement a response to those challenges, but compared to the performance in the rest of the UK, Scotland's NHS stands up to scrutiny and we should be proud of its achievements. We have 11,000 more staff since coming to power, but we have vacancies that we need to address. Neil Findlay mentioned the issue of what patients think. Of course, 90 per cent of inpatients have rated treatment as good or excellent. That is not to say that there are not challenges. Of course there are, but there are still high satisfaction rates with our NHS, and that is something that we should welcome. I have written to Neil Findlay in response to the concerns that were raised about Mr Nielsen. He should get that response today, and I hope that the contents of that letter will be welcomed by him and, indeed, by Mr Nielsen. It should not take us to raise constituency cases at First Minister's question time to get results for constituents who are sitting in pain at home. Cabinet Secretary, I agree, and that is why we are working with NHS Lothian to improve the outpatient performance, and, as I said, we will have more to say about that shortly. Alison Johnstone made some important points about the debates that we have in this place, and she talked about not retreading the same debates and, indeed, needing to look at sustainable funding and models and for all of us to perhaps face up to some of the difficult issues. I agree with that, and I hope that perhaps we can inject a more mature debate around some of those difficult issues. I am sorry, cabinet secretary. I have to stop your air on mature debate. It seems a good place to stop. I will do what is right to members with responses to their issues, particularly Alex Cole-Hamilton. Thank you very much. Yes, I understand. Now I will call Brian Whittle, please, to 5.30, please. Thank you, Deputy Presiding Officer. Given the extraordinary health pressures that we face from a rapidly ageing population, dwindling birth rates, changes in working patterns, evolving technology and an ever-expanding health gap between rich and poor, it should be obvious to all that the status quo definitely cannot be an option. Those are the words from the Care report commissioned in 2005 by a past Scottish Government, yet, since then, its recommendations have done little more than gather dust on a shelf. Here we sit, approaching the end of 2016, and precisely none of those issues Professor David Kerr mentioned are any less prevalent. The cabinet secretary has stated that the Scottish Government is spending more money on the NHS, but as many outside this chamber in the real world understand, it is not about the amount of money that you spend that is key, it is what you spend it on. In other words, effective budgeting and planning is required. Prevention is often mentioned in this chamber in health debates, but in reality there is scant evidence of any kind of move by this Government towards that kind of innovative approach. The explosion in cases of type 2 diabetes now accounts for some 12 per cent of the Scottish health budget. According to Sam H, the rise in poor mental health is costing the economy some £3.6 billion per year. Musculoskeletal issues are costing excess of £350 million a year, and along with the likes of cardiovascular disease and strokes, those conditions are costing NHS Scotland not just money, but shortening the life expectancy and reducing quality of lives. All of the above are fundamentally affected by inactivity or obesity or both. The obvious answer is to set up a long-term strategy to tackle those mounting issues, which are putting more unnecessary strain on our NHS. Actions speak louder than words, so let's look beyond the words of the ministers in this chamber and look at the Scottish Government's actions. Jog Scotland, who have 40,000 weakly active members, 80 per cent of them women, given the opportunity for organised exercise in a safe environment, are having their funding cancelled. £100,000 equates to £2.50 per person per year to positively impact on their health and wellbeing now and in the future, not to mention the likely related health and wellbeing impact on their families. Swimming lessons are not compulsory in Scottish primary schools, yet they are in England. The Scottish Government has pulled the £1.72 million top-up funding— There is a wee bit too many conversations going on. Do the member the privilege and the politeness of listening to what he has to say? Thank you, Deputy Presiding Officer. The Scottish Government has pulled the £1.72 million top-up funding to support school swimming lessons. The result is 40 per cent of children, about 15,000 each year, head to high school as non-swimmers, according to the Scottish swimming, and a higher percentage lives in socially deprived areas. There is much talk of health inequality, inequality of opportunity and closing the attainment gap, but all the evidence is pointed to the fact that exactly the opposite is happening, yet expert advice from agencies is falling on deaf SNP ears. In the words of Tolstoy, the most difficult subjects can be explained to the most slow-witted person if they are not formed of any idea of them already, but the simplest thing cannot be made clear to the most intelligent person if they are firmly persuaded that they know already. That, to me, in my short time, so far in this building has tiffified the approach of this Government, they know better than everybody else. None of us in this chamber should be surprised that the first bill put out in consultation by this Government was about independence. Disappointed yet, but not surprised. However, with this damning Audit Scotland report, we see the consequences of a Scottish Government who are forgotten that are responsible for more than satisfying their own constitutional obsession. The SNP spent years, millions of pounds, countless hours of resource on a 650 page plan for independence. Is there any possibility of them devoting even a fraction of the energy that they put into that to a long-term sustainable plan for the Scottish NHS? The Scottish Conservatives were voted into this chamber to be a strong opposition and to hold the Government to account. Rest assured, we accept that role and will do that to the very best of our ability every day of this parliamentary term. However, sometimes issues arise that transcend party politics, and we believe that that is one of those issues. With the publishing of the Audit Scotland report, it is now for all to see that our most precious of services to the NHS is under increasingly intolerable pressures. Therefore, it must be the duty of all opposition parties in this chamber to ensure that this Government's lack of initiative, lack of focus and continued attempts to duck their responsibilities is called to account. The SNP's cunning plan to avoid criticism of the NHS plan by having no plan at all cannot be allowed to go unchallenged. Our NHS deserves better, the Scottish public will demand better, and this SNP Government needs to be shaken out of its constitutional daydreaming and therefore commend this motion to the House. The next item of business is consideration of business motion 2270, in the name of Jofits Patrick, on behalf of the Parliamentary Bureau, setting out a business programme. I would ask any member who wishes to speak against the motion to press their request to speak button now. I call on Jofits Patrick to move motion 2270. No member has asked to speak against the motion. I will put the question to the chamber. The question is that motion 2270, in the name of Jofits Patrick, be agreed. Are we all agreed? Yes. The next item of business is consideration of five parliamentary bureau motions. I would ask Jofits Patrick to move on block motions 2120, 2271, 2274 and 2275 on the approval of SSIs, and motion 2273 on the office of the clerk. Thank you. The question on those motions will be put at decision time to which we now come. There are six questions today, but the first question is that amendment 2231.1, in the name of Annabelle Ewing, which seeks to amend motion 2231, in the name of Douglas Ross, on justice, be agreed. Are we all agreed? No. We are not agreed. We shall move to a vote and members may cast their votes now. The result of the vote on amendment 2231.1 in the name of Annabelle Ewing is yes, 63, no, 64. The amendment is therefore not agreed. The next question is that motion 2231, in the name of Douglas Ross, be agreed. Are we all agreed? Yes. We are not agreed. We shall move to a vote and members may cast their votes now. The result of the vote on motion 2231, in the name of Douglas Ross, is yes, 64, no, 63. The motion is therefore agreed. I remind members that, if the amendment in the name of Shona Robison on the NHS in Scotland is agreed, the amendment in the name of Anas Sarwar falls. The first question is that amendment 2232.3, in the name of Shona Robison, which seeks to amend motion 2232, in the name of Donald Cameron, on the NHS in Scotland 2016, be agreed. Are we all agreed? Yes. We are not agreed. We shall move to a vote and members may cast their votes now. The result of the vote on amendment 2232.3, in the name of Shona Robison, is yes, 69, no, 58. There were no abstentions. The amendment is therefore agreed. The amendment in the name of Anas Sarwar falls. The next question is therefore that motion 2232, in the name of Donald Cameron, as amended, on the NHS in Scotland, be agreed. Are we all agreed? We are not agreed. We shall move to a vote and members may cast their votes now. The result of the vote on motion 2232, in the name of Donald Cameron, as amended, is yes, 67, no, 60. There were no abstentions. The motion as amended is therefore agreed. Now, I propose to ask a single question on parliamentary bureau motions 2120, 2271, 2274, 2275 and 2273. If any member objects, please say so now. In that case, no member is ejected. The question is that motions 2120, 2271, 2274, 2275 and 2273, in the name of Joe Fitzpatrick, be agreed. Are we all agreed? We are all agreed. That concludes decision time. Parliament will listen to Mr Kelly's point of order, please. I rise, Presiding Officer, to make a point of order under rule 8.17 of the standing orders. The Offensive Behaviour Football Act and Threatening Communications Act is clearly dead in the water after tonight's vote. The Government must therefore bring forward immediate plans on how it will repeal the act as a matter of urgency. I ask Presiding Officer how he will authorise that within the remit of the Parliament. Thank you. I would thank Mr Kelly for raising the point of order. In that case, if I may explain to Parliament, as I think most members will know, resolutions of the Parliament are not binding. However, the Parliament has made its voice and its views clear, and it is for the Scottish Government to reflect on how to respond. That concludes decision time. We shall now move to members' business. I would ask members to please change seats quietly as possible.